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Mental health counselors and academicians can be key agents in helping community leaders monitor issues by bringing basic methodological expertise to the fore. Communities need to use realistic data in assessing the magnitude of problems and in monitoring effective intervention programs. Mental health counselors need to educate leaders to the importance of using accurate process and outcome evaluation models. Effective data collection can help correct poor intervention models. Sometimes, some interventions are just inadvisable, or even destructive; strip searches are one illustration of an intervention that has yielded negative results (Hyman Celexa 10, 20, 30, 40, 50 mg Tablets (Capsules)). Mental health counselors need to help communities learn when and where limits need to be exerted with interventions for children.

SUMMARY

Mental health professionals need to appreciate both the complexity of childhood violence as well as the difficulty developing and receiving support for comprehensive counseling initiatives. It is important to continually keep in mind the important role early counseling initiatives can play in helping violent children break the cycle of violence. Specifically, counselors should:

• Consult with administrators about the importance of providing individual, group, and family counseling programs.

• Provide anger management, behavior management, and parent education classes for parents, community agencies, and schools.

• Consult with community leaders about developing alternative programs for adolescents.

• With colleagues, develop peer supervision groups to discuss the complexities of ethical clinical treatment issues.

• Build professional relationships with local law enforcement agencies surrounding shared interests and common issues.

• Encourage the development of violence prevention programs with elementary-age children.

• Foster social skills training to develop resiliency.

Finally, as has been noted throughout this cheap Celexa, mental health professionals need to be advocates for funding the types of treatment programs that have shown some effectiveness in the literature and that can be evaluated in future research.

Approximately 20% of women will be raped in their lifetime (Koss 5 mg, 10 mg, 25 mg, 50 mg, 100 mg Tablets (Capsules)). Given that an assault history is associated with increased risk of mental and physical health problems, the prevalence of sexual assault in clinical samples is even higher. Thus, knowledge regarding the assessment and treatment of rape survivors is important for clinicians.

This cheap Celexa provides a concise summary of research on the effects of adult sexual assault and rape (terms we use interchangeably), factors associated with recovery, and the efficacy of various treatment approaches. Because the vast majority of rape survivors are women, we focus on the assessment and treatment of female survivors. We also include some research on Posttraumatic Stress Disorder (posttraumatic stress disorder) more generally, as posttraumatic stress disorder is the most common response to sexual assault and because the literature on posttraumatic stress disorder is much larger than that on rape. Following this review, we offer specific recommendations regarding the

Webster-Stratton, C. (Celexa). Strategies for helping early school-aged children with ODD and CD: The importance of home-school partnerships. School Psychology Review, 22, 437-457.

Zigler, E., Taussig, C, & Black, K. (Celexa). Early childhood intervention: A promising preventa-tive for juvenile delinquency. American Psychologist, 47, 997-1006.

assessment and treatment of rape survivors. Given space constraints, only new research findings are cited; review articles are listed at the end that interested readers can consult for additional information.

RESEARCH FINDINGS

Effects of Sexual Assault

posttraumatic stress disorder is one of the most common responses to having been sexually assaulted. The primary symptoms of posttraumatic stress disorder are reexperiencing the event, avoiding reminders of the event, and increased arousal (DSM-IV; APA 2 5 mg Tablets (Capsules)). The majority of sexual assault survivors meet diagnostic criteria for posttraumatic stress disorder in the first few months postassault and approximately half continue to have posttraumatic stress disorder one year postassault. Studies comparing posttraumatic stress disorder rates across events indicate that rape survivors are more likely than survivors

RESPONDING TO SURVIVORS OF SEXUAL ASSAULT

36 • RESPONDING TO SURVIVORS OF SEXUAL ASSAULT 253

of other traumas to meet diagnostic criteria for posttraumatic stress disorder (PTSD). In addition, posttraumatic stress disorder has a high comorbid-ity rate with other disorders among survivors of rape and other traumas.

Given this high comorbidity rate, it is not surprising that research has documented several other psychological and physical symptoms that are more common in rape survivors than in comparison groups. Depression is among the most prevalent of these, with up to almost half of survivors diagnosed with a depressive disorder. Relatedly, survivors are at higher risk for suicidal thoughts and attempts. Survivors also are at increased risk of experiencing fear, anxiety, negative changes in their beliefs about themselves and the world, sexual dysfunction, social adjustment problems, eating disorders, substance abuse, and physical health problems. Survivors also engage in more health risk behaviors, such as smoking (Brener, McMahon, Warren, & Douglas 150, 200, 250, 300, 500 mg Tablets (Capsules)).

Despite these problems, many survivors also report positive changes in their lives. The most frequent of these are increased empathy for other survivors, greater appreciation of life, greater recognition of their own strength, and increased assertiveness. These self-reported positive changes tend to be associated with lower distress levels (Frazier, Conlon, & Glaser 2 5 mg Tablets (Capsules)).

Factors Associated with Postrape Symptoms

Although survivors are at greater risk for experiencing various psychological and physical problems, there also is great variability in the extent to which survivors are affected by an assault. Knowledge of these factors also is essential to developing a thorough assessment and treatment plan.

Survivor Characteristics. Factors reliably associated with greater postrape distress include prior victimization, which is very common, and prerape psychological problems. Data regarding demographic characteristics are mixed, although there is some evidence that older survivors and those of lower socioeconomic status experience more distress. Research examining differences in postrape distress among women of different ethnocultural groups has not yielded consistent results (Neville & Heppner 150, 200, 250, 300, 500 mg Tablets (Capsules)).

Assault Characteristics. A recent meta-analysis of factors predicting distress levels following interpersonal violence identified several assault-related factors associated with greater distress, including, in order of importance, subjective distress associated with the event, perceived life threat, and greater force (Weaver & Clum 12.5, 15, 37.5, 7 5 mg Tablets (Capsules)). Perhaps relatedly, greater dissociation or detachment during a traumatic event is a risk factor for later distress. Greater distress immediately following the trauma also is associated with more persistent symptoms.

One assault factor that tends not to be associated with distress levels is the relationship between the survivor and assailant. Specifically, most studies show no differences in distress levels between survivors of stranger and acquaintance rape.